La paradoja del iboga: intoxicación por un remedio natural de desintoxicación / The paradox of iboga: intoxication by a natural detoxification remedy

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Efficacy of Paracetamol in Closure of Ductus Arteriosus in Infants under 32 Weeks of Gestation.

BACKGROUND: Standard medical treatment for patent ductus arteriosus (PDA) closure has been indomethacin/ibuprofen or surgical ligation. Up to date, new strategies have been reported with paracetamol. The aim of this study was to present our experience with intravenous paracetamol for closing PDA in preterm neonates presenting contraindication to ibuprofen or ibuprofen had failed and no candidates for surgical ligation because of huge instability. MATERIALS AND METHODS: We conducted a retrospective case series study in a neonatal intensive care unit from a tertiary hospital. 9 preterm infants ≤32 weeks of gestational age with hemodynamically significant PDA (hsPDA) were enrolled. They received 15 mg/kg/6h intravenous paracetamol for ductal closure. Demographic data and transaminase levels before and after treatment were collected. RESULTS: 30 preterm babies were diagnosed of hsPDA. 11/30 received ibuprofen with closure in 81.1%. 9 received intravenous paracetamol mainly due to bleeding disorders or thrombocytopenia. Successful closure on paracetamol was achieved in seven of nine babies (77.7%). There was a significant increase in transaminase levels in two patients. They required no treatment for normalization. CONCLUSION: Paracetamol is an effective option in closure PDA. It should be a first-line therapeutic option when there are contraindications for ibuprofen treatment. Transaminases must be checked during treatment.

Vivir con un trastorno bipolar. ¿Qué opinan los pacientes? / Living with a bipolar disorder. the patient´s view

Fundamentos. El trastorno bipolar genera un creciente interés dadas sus elevadas repercusiones e implicaciones clínicas. Fruto de ello han aparecido unidades específicas destinadas a su estudio, así como asociaciones de pacientes y familiares. Conocer el punto de vista del paciente resulta un asunto clave en la práctica clínica que puede redundar en una mejoría en el curso clínico. Método. 122 pacientes diagnosticados de trastorno bipolar completaron un cuestionario que recogía datos sociodemográficos y clínicos, junto con aspectos variados de la enfermedad como actitud del paciente frente al tratamiento farmacológico, terapia electroconvulsiva y grupos psicoeducativos, demandas y propuestas, impacto personal, laboral y social, y causas, entre otras cuestiones. Resultados. Destacaron aspectos como un elevado error diagnóstico inicial, un retraso considerable en el diagnóstico, un mayor temor a las fases depresivas, un alto porcentaje de antecedentes de abandono del tratamiento, un avance con los fármacos más recientes, y la percepción de un alto grado de disfunción en distintos ámbitos, entre otras conclusiones. Estos resultados y una revisión de la literatura en torno a estos temas permitió extraer algunas conclusiones orientadas a mejorar la atención clínica y la evolución de estos pacientes. Conclusiones. Se debe realizar un esfuerzo a la hora de reconocer y diagnosticar adecuadamente el trastorno bipolar. Tener en cuenta el punto de vista del paciente, su actitud ante la enfermedad y considerar sus demandas debe formar parte de la práctica clínica diaria. Una información adecuada sobre el trastorno resulta indispensable; en este sentido los grupos psicoeducativos ejercen un apoyo fundamental

Background. Over the last fwe years there has been increasing interest in bipolar disorder due to its high level of repercussions and clinical implications. This has resulted in the appearance of units specifically devoted to its study and organisations for patients and relatives. Understanding the patient´s point of view is vital in everyday clinical practice and can lead to improvements in clinical progress. Methods. 122 bipolar patients answered a survey that collected data on demographic and clinical characteristics and various aspects of the illness such as attitudes towards pharmacological treatment, electroconvulsive therapy and psychoeducative, groups, needs and suggestions, impact on work, personal and social life, and causes, among other questions. Results. The chief points were a high percentage of mistaken initial diagnosis, long delays between the onset of symptoms and diagnosis, greater fear to the depressive phases, a high percentage of voluntary cessation of medication, a sense of improvement with the most recent drugs and the perception of a high degree of dysfunction in various different fields, among other conclusions. These results, and a review of literature on the subject, made it possible to draw some conclusions aimed at improving the clinical treatment and prognosis of these patients. Conclusions. Efforts must be made correctly to recognise and diagnose bipolar disorder. Taking our patients´ demands and points of view into consideration can help us in everyday clinical practice and improve their prognosis and quality of life. Along with other medical interventions, psychoeducative groups, providing the necessary information about the disorder, offer essential support

Variables demográficas, clínicas y psicológicas que influyen en la falta de asistencia a la primera consulta en salud mental / Demographic, clinical, and psychological variables influencing non-attendance at first mental-health appointment

Objetivos. Identificar las variables demográficas, clínicas y psicológicas de tres grupos de pacientes tras haber sido remitidos a psiquiatría desde Atención Primaria: los que no llegan a solicitar fecha de visita, los que la solicitan y no acuden, y aquellos que la solicitan y acuden. Elaborar estrategias para evitar fallos de asistencia a las primeras consultas. Método. Estudio observacional secuencial de recogida durante 18 meses de datos de todos los pacientes derivados al Centro de Salud Mental. Instrumentos utilizados: petición de interconsulta, cuestionario clínico (SCL-90r de Derogatis), cuestionario de personalidad (EPI de Eysenck), hoja de registro de datos demográficos, y entrevista semiestructurada telefónica.Resultados. Las variables demográficas significativas fueron el estado civil, los pacientes casados acudían más a las primeras visitas y la presencia o no de hijos en casa, aquellos con hijos en casa acudieron más. Los de menor nivel de estudios solicitaron cita con menor frecuencia y los que disponían de teléfono, más. El resto de variables no resultaron significativas. No se obtuvieron variables psicológicas, ni clínicas que diferenciaran los tres grupos. El tiempo prolongado de espera y la mejoría clínica fueron las caúsas más frecuentes para no acudir tras haber solicitado cita, y la mejoría clínica y considerar que la derivación se había debido a un motivo insuficiente, en caso de no llegar a hacerlo. Conclusiones. Un 7% de los pacienes derivados a Salud Mental no llegan a solicitar cita. Los datos demográficos ofrecen resultados dispares. Los cuestionarios SCL-90 y EPI no permitieron determinar características clínicas y psicológicas de los pacientes “incumplidores”. Estrategias como disminuir las listas de espera, y revisar los criterios de derivación podrían resultar útiles para reducir el incumplimiento

Objectives. To identify the demographic, clinical, and psychological variables in three groups of patients who were referred to psychiatric services by primary-care services: those who do not request an appointment, those who request one but do not attend, and those who request one and attend. To design strategies to prevent non-attendance at first appointments. Method. An 18-month sequential observational study that recorded the data of all patients referred to the Mental Health Centre. Instruments used: inter-service referral form; a clinical questionnaire (the Derogatis SCL-90-R), a personality questionnaire (the Eysenck EPI), a demographic information form; and a semi-structured telephone interview. Results. The significant demographic variables were marital status and the presence of children in the home. Patients with lower educational levels requested appointments less frequently, and those with telephones requested them more frequently. The remaining variables were not statistically significant. No psychological or clinical variables were found to distinguish between the three groups of patients. The most frequent causes of non-attendance after requesting an appointment were long waiting times and clinical improvement, while the most frequent reasons for not requesting an appointment were clinical improvement and the belief that there were insufficient grounds for psychiatric referral. Conclusions. 7 percent of patients referred to Mental Health Services do not even request an appointment. Demographic data still offer disparate results. The SCL-90 and EPI questionnaires did not make it possible to identifv the clinical and psvchological characteristics of non-attending patients. Strategies such as shortening waiting lists and reviewing the criteria for referral could prove useful in reducing non-attendance